Healthcare Provider Details

I. General information

NPI: 1851119291
Provider Name (Legal Business Name): SARA ROBERTS ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 OLDE STAGE RD
BOULDER CO
80302-9405
US

IV. Provider business mailing address

5400 OLDE STAGE RD
BOULDER CO
80302-9405
US

V. Phone/Fax

Practice location:
  • Phone: 360-632-7170
  • Fax:
Mailing address:
  • Phone: 360-632-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPN.1002102-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: